Detecting and Diagnosing Esophageal Cancer

*Please note: This slide show represents a visual interpretation and is not intended to be a substitute for medical and/or clinical advice.

What is esophageal cancer?

Esophageal cancer is a serious form of cancer.

It often causes no symptoms until it is advanced and hard to treat. Only one out of 5 people diagnosed survives more than 4 years.

What is esophageal cancer?

Esophageal cancer is more common among adults over 50. It is 4 times more common in men than women.

Types of esophageal cancer

The 2 main types of esophageal cancer are:

• Esophageal squamous cell carcinoma, or ESCC
• Esophageal adenocarcinoma, or EAC, which is the most common type found in Western societies

Preventing esophageal adenocarcinoma

Esophageal adenocarcinoma begins with a condition known as Barrett's esophagus.

Barrett's causes no symptoms, but may cause the pain of heartburn to stop.

Preventing esophageal adenocarcinoma

Barrett's develops when stomach fluids repeatedly splash into the esophagus and its lining adapts to the reflux by functioning more like the lining of the stomach.

Once detected, Barrett's esophagus can be treated and eliminated, preventing the start of esophageal adenocarcinoma.

Watching for Barrett’s esophagus

Because Barrett's esophagus is silent, it is important to watch for symptoms of reflux disease, or GERD, including:

• Heartburn
• A cough, hoarse voice, sore throat, or painful swallowing
• Feeling like there is a lump in your throat or food gets stuck
• Burping, nausea, regurgitation, and vomiting
• Chest pain
• A choking sensation when you lie down
• Tooth erosion

Is there a screening test for Barrett’s esophagus?

A test called an upper endoscopy is the best way to find Barrett's esophagus. A doctor places a thin, lighted tube with a tiny camera down your throat. This allows for a close look at your esophagus and the chance to take tissue samples. You will be sedated to keep you comfortable during the test.

New tests for Barrett’s esophagus

A variety of screening tests that do not require you to be sedated are becoming available. Most involve a capsule you can swallow that will gather small amounts of tissue or even take images.

You will still need an endoscopy if the tests show signs of Barrett's esophagus or cancer.

Barrett’s esophagus without abnormal cells

If your doctor finds Barrett's esophagus, he or she will prescribe testing and treatment based on the number of abnormal cells.

• If there are no abnormal cells, you need another endoscopy in 2 or 3 years. The diagnosis is non-dysplastic Barrett's esophagus.
• If cells are not clearly abnormal, you need another endoscopy in 3 to 6 months. The diagnosis is indefinite for dysplasia. 

Barrett’s esophagus with abnormal cells

• If a few cells are abnormal, you may need treatment, plus another endoscopy in 6 to 12 months. The diagnosis is low-grade dysplasia.
• If many cells are abnormal, high-grade dysplasia is present and the risk of cancer is high. You need treatment, plus another endoscopy when your doctor recommends it.

Lowering your risk for esophageal cancer

Finding and treating Barrett's esophagus can stop cancer before it starts. Early diagnosis of any type of esophageal cancer results in a better chance for survival.

Lowering your risk for esophageal cancer

If your endoscopy does show esophageal cancer, you may have endoscopic ultrasound, CT and PET scans, advanced endoscopy, or even exploratory surgery to determine the cancer stage.

Stages of esophageal cancer

Esophageal cancer has 4 stages:

• In stage 1 and 2, the cancer is only in the esophagus, either on the surface or deeper in the tissues.
• In later stage 2 and stage 3, the cancer has spread through the esophagus, reaching the body's infection-fighting system, and invading nearby lymph nodes.

The lymph glands help the body fight disease, but they are also connected by channels that allow cancer cells to travel around the body.

Stages of esophageal cancer

• In stage 4 esophageal cancer, the cancer has spread from the esophagus and nearby lymph nodes to other areas of the body. This is called metastatic or advanced cancer.

In 7 out of 10 people in the US, esophageal cancer is not found until it has spread outside the esophagus, either to the lymph nodes or beyond.

Importance of early esophageal cancer detection

If you are diagnosed with esophageal cancer before it has spread, you are at least 8 times more likely to survive than someone whose cancer has spread to other parts of the body.

Talk with your doctor about your risk for esophageal cancer or Barrett's esophagus.

References

1. American Cancer Society. Esophageal cancer risk factors. Last revised: June 9, 2020.
   https://www.cancer.org/cancer/types/esophagus-cancer/causes-risks-prevention/risk-factors.html. Accessed May 22, 2023.
2. American Society of Clinical Oncology Cancer.Net. Esophageal cancer: Stages and grades. Approved September 2022.
   https://www.cancer.net/cancer-types/esophageal-cancer/stages-and-grades. Accessed May 22, 2023.
3. OncoLink. Esophageal cancer: The basics. Last reviewed: March 30, 2023.
   https://www.oncolink.org/cancers/gastrointestinal/esophageal-cancer/esophageal-cancer-the-basics. Accessed May 22, 2023.